Health and well-being among 70-year-old migrants living in Sweden--results from the H 70 gerontological and geriatric population studies in Göteborg

Older migrants' perceptions of places to meet: Insights for social work practice

This study aimed to explore the experiences of older migrants' (70+) access to and participation in different meeting places. Qualitative interviews were conducted with participants originating from Finland and four countries in the Western Balkans: Bosnia- Herzegovina, Croatia, Montenegro, and Serbia. The participants used everyday places in the neighborhood, which were not primarily meant to be meeting places, to create and uphold social contacts. These meeting places contributed to experiences of community and trust. Both everyday meeting places and organized meeting places were used to establish and develop relationships that could result in an exchange of both practical and emotional support. Perceptions of "not belonging", limited proficiency in Swedish, and a strained financial situation created barriers to accessing some meeting places. The results of this study demonstrate the significance of meeting places that are not purposefully aimed at older people in general or older people from a specific country.

Evaluation of bio-psycho-social and socio-cultural problems of Syrian elderly living in Turkey

BACKGROUND

Older persons are among the vulnerable groups most affected by war and migration due to physical weakness, illness, social environment, and cultural adaptation difficulties.

AIMS

The aim of this study is to determine the economic, biopsychosocial, and socio-cultural problems of the older Syrians living in Turkey.

METHODS

Convergent mixed design was used within the scope of the research. For the qualitative phase of the research, 19 older persons migrants were interviewed. A semi-structured interview form was used to collect data in the interviews. For the quantitative phase of the research, 432 participants were reached. In order to collect data, Geriatric Depression Scale (GDS-15) and Socio-cultural Adaptation Scale (SCAS-R) were used together with the demographic information form.

RESULTS

The mean age of the participants was 66.2 ± 7.10 (Min: 60; Max: 91), the majority (87%) between the ages of 60 to 74 and 53.2% were male. The mean SCAS-R score of the older Syrians was 2.48 ± 0.88 (Min: 1; Max: 5) and the mean GDS-15 was 2.63 ± 3.84 (Min: 0; Max: 15). About 22.7% of older Syrian participants had mild or severe depressive symptoms. Experienced traumatic events, changing economic situation, and family relationships affected both physical and mental health of the older persons. The socio-cultural adaptation of the older persons was affected by language, temporary protection, and exposure to exclusion. The Older Syrians, who lacked information on social services, were experiencing problems with nutrition, clothing, bill payment, and rent due to economic problems. However, they mostly did not want to return to Syria because their living order in Syria was deteriorating and they were afraid.

CONCLUSION

Syrian elderly immigrants living in Turkey have biopsychosocial, economic, and cultural problems. National and international support programs and policies should be developed for elderly Syrian refugees who are expected to live in Turkey unless a safe living environment is provided.

Association Between Intergenerational Support, Social Integration, and Subjective Well-Being Among Migrant Elderly Following Children in Jinan, China

Background

In China, as domestic urbanization progresses and immigration expands, an increasing number of older people are choosing to follow their migrant children to new cities. Such people are referred to as "migrant elderly following children." However, few studies have explored the subjective well-being of these older adults. The present study aims to investigate the factors that influence the subjective well-being of this population of older adults.

Methods

This cross-sectional study was conducted among 656 older migrants who had followed their children to Jinan, Shandong Province, China. Multistage cluster random sampling was used. Binary logistic regression analyses were performed to explore, the relationships between intergenerational support, social integration, and subjective well-being.

Results

Overall, 96.3% of the older migrants showed good subjective well-being. Analysis of intergenerational support showed that those who had a female child (odds ratio [OR] = 0.401, 95% confidence interval [95%CI]: 0.180, 0.893) and those whose children had terrible conjugal relationships (OR = 0.223, 95% CI: 0.099, 0.504) were less likely to have better subjective well-being. Analysis of social integration showed that migrants who liked their current city (OR = 5.358, 95%CI: 1. 631, 17.599) and those who had a basic understanding of the local dialect (OR = 2.869, 95%CI: 1.203, 6.843) were more likely to have good subjective well-being. Migrants who had used in-patient service in the past year (OR = 0.216, 95%CI: 0.094, 0.497) were more likely to have poor subjective well-being.

Conclusion

Intergenerational support and social integration are positively associated with the subjective well-being of migrant elderly following children in China. Efforts should be made, including the creation of specialized policies, to improve the family atmosphere of such migrants and their integration into their new cities, as this would contribute to improving their subjective well-being.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

Depression in middle-aged and older first generation migrants in Europe: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objective

To determine the prevalence of depression in migrants aged 50 years or older in comparison to residents without a history of migration in 11 European countries.

Methods and subjects

The Survey of Health, Ageing and Retirement in Europe (SHARE), a cross-national, multidisciplinary, household-based panel survey using nationally representative probability samples (n = 28,517) of 11 European countries of the non-institutionalized population aged 50 years and older. Depression was measured using the EURO-D scale, and odds ratios (OR) were estimated for migration status. Effects of sociodemographic variables, somatic comorbidities, functional impairment, cognitive function, geographic region, and time lived in current country of residence were assessed in multivariate logistic regression analysis.

Results

Adjusting for confounds, the OR for depression in migrants was 1.42 (95% CI, 1.28–1.59). The influence of migration status on the prevalence of depression was significantly greater in Northern (OR, 1.85; 95% CI, 1.39–2.46) and Western Europe (OR, 1.38; 95% CI, 1.22–1.57), compared to Southern Europe (OR, 1.16; 95% CI, 0.79–1.70) (p < 0.05 for the interaction).

Conclusion

We found a higher prevalence of depression in first-generation migrants aged 50 years or older, together with relevant geographical variation. This difference was not due to other known predictors of depression in older age.

Social position and geriatric syndromes among Swedish older people: a population-based study

Background

Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers.

Methods

Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65–84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress.

Results

The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13–3.15).

Conclusion

GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.

Prevalence, trend and contributing factors of geriatric syndromes among older Swedes: results from the Stockholm County Council Public Health Surveys

Background

Evidence is scarce on the trend in prevalence of geriatric syndromes (GS). This study assesses how GS prevalence changes over time in Swedish older community-dwellers by socio-demography, and attempts to highlight factors that may contribute to explain the trend.

Methods

Data from Stockholm County Council Public Health Surveys in 2006, 2010 and 2014 were used. Old adults, aged 65–84 years, with measurements on GS items were identified. Thus, a total of 17,560 participants were selected in 2006 (n = 6295), 2010 (n = 6733) and 2014 (n = 4532). Data on socio-demographics, lifestyles and health status were collected through questionnaires. GS was defined as having at least one of the following: insomnia, urinary incontinence, severe hearing/vision problem, functional decline, fall and depressive disorder. Logistic regression was performed to assess the prevalence trend as well as the change in the associations of sociodemographic factors, health behaviors and chronic disease with GS.

Results

From 2006 to 2014, the prevalence of GS remained stable (P_trend = 0.54). However, among old adults born outside Nordic countries, it increased significantly from 73.0% in 2006, 78.0% in 2010 to 83.0% in 2014 (P_trend < 0.001). Furthermore, the association with GS became stronger for born outside Nordic counties (P_trend < 0.001) and weaker for sedentary lifestyles (P_trend = 0.004), whereas the association did not change for other sociodemographic factors, health behaviors and chronic disease (all P_trend > 0.05).

Conclusions

At population level, GS prevalence remained stable at a high level among Swedish old community-dwellers. There are noteworthy differences in GS trend between population groups, in particular to the detriment of older adults born outside Nordic countries.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-1018-6) contains supplementary material, which is available to authorized users.

Sociopolitical Control for Immigrants: The Role of Receiving Local Contexts

This study examines the individual and contextual factors associated with sociopolitical control expressed by immigrants in southern Spain. We used hierarchical linear modeling to evaluate the relations between individual (community participation, social connectedness, and perceived cultural competence of receiving community services) and municipality characteristics (city community participation, city social connectedness, and city community services' cultural competence) and immigrants' feelings of sociopolitical control. Data were analyzed using a two-level model based on 707 Moroccan immigrants in 25 municipalities. After adjusting for gender, educational level, and psychosocial confounding factors, we observed a positive association between social connectedness and sociopolitical control at the individual level. At the contextual level, we observed a positive association between (a) city community participation, (b) city social connectedness, and (c) city community services' cultural competence, and sociopolitical control. Indeed, living in a municipality where there are community services with high levels of cultural competence and where, on average, many people participate in organizations and neighbors are connected, was associated with higher levels of perceived control in the sociopolitical domain for immigrants. We also discuss implications for community-based research and practice.

Stress and Distress in Migration: Twenty Years After

Based on qualitative interviews with a group of immigrant women, “Stress and Distress in Migration: Problems and Resources of Turkish Women in Denmark” was published in this journal in 1984. Twenty years later, the same group was contacted and reinterviewed with the purpose of investigating the changes that had taken place in actual living conditions and subjective perception of well-being. Although the material situation of the women had markedly improved, and the number of somatic complaints had decreased, the level of distress was still high twenty years later. The changes in the women's conditions, expressions of grief, and implications for interventions are discussed.

Health of Immigrants in European countries

The health of older immigrants can have important consequences for needed social support and demands placed on health systems. This paper examines health differences between immigrants and the native-born populations aged 50 years and older in 11 European countries. We examine differences in functional ability, disability, disease presence and behavioral risk factors, for immigrants and non-immigrants using data from the Survey of Health, Aging and Retirement in Europe (SHARE) database. Among the 11 European countries, migrants generally have worse health than the native population. In these countries, there is a little evidence of the "healthy migrant" at ages 50 years and over. In general, it appears that growing numbers of immigrants may portend more health problems in the population in subsequent years.

Promoting aging migrants' capabilities: A randomized controlled trial concerning activities of daily living and self-rated health

The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.

The Effects of Immigrant Status and Age at Migration on Changes in Older Europeans’ Health

The purpose of this study was to determine the differences between natives and immigrants in regard to transition probabilities among health states in self-rated health (SRH), depression, and activities of daily living for middle-aged and older adults in Europe. The Survey of Health, Aging, and Retirement allows us to investigate how successfully the immigrants have aged from 2004 to 2011 compared to natives, according to country of origin and age at migration. We showed that some groups, such as Eastern European immigrants, have higher probabilities of health deterioration in terms of SRH. Moreover, those immigrants who arrived in the host country during adulthood experienced relatively fast health decline.

Supporting decision-making by a health promotion programme: experiences of persons ageing in the context of migration

This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

Biological aspects of human migration and mobility

This paper reviews how migration, both geographical and social, impacts on variation in some human biological traits. Migration and mobility are considered in relation to anthropometric traits and indices, psychometric traits, health, disease and nutrition, temperature regulation and metabolism, mental health and gene flow. It is well known that migration is important in disease transmission but, as this paper demonstrates, migration can have both positive and negative impacts on both donor and recipient populations for a wide range of human traits.

Comparing Predictors of Positive and Negative Self-Rated Health Between Younger (25-54) and Older (55+) Canadian Adults

The objectives of this study were to explore age variations in predictors of positive and negative self-rated health and examine whether the determinants of positive and negative self-rated health are mirror images. Longitudinal data were used from the National Population Health Survey for a nationally representative cohort of Canadians aged 25 years and older ( N = 9,371) to predict positive and negative self-rated health among younger and older Canadian adults separately. Self-rated health was confirmed as a multidimensional concept. There were variations in determinants of positive and negative self-rated health for the younger and the older Canadian adults. Determinants of self-rated health include but are not limited to physical health and functioning. Self-rated health is a dynamic evaluation influenced by changes over time in individuals' physical and psychosocial health, genetic endowment, socioeconomic status and health behaviors. Determinants of positive and negative self-rated health are not mirror images.

Bridging barriers to health promotion: a feasibility pilot study of the 'Promoting Aging Migrants' Capabilities study'

RATIONALE, AIMS AND OBJECTIVES

Improving the possibilities for ageing persons to take control over their health is an increasingly important public health issue. Health promotion has previously been visualized to succeed with this goal, but research has primarily focused on ageing persons who are native-born, leaving the generalizability to persons who are foreign-born unexplored. Therefore, as part of the development of a larger health promotion initiative for ageing persons who have experienced migration, this study aimed to assess the feasibility of an adapted protocol. The specific feasibility objectives were to assess recruitment procedure, retention rates, study questionnaire administration and variability of collected data.

METHOD

Forty persons who were ≥70 years, and who had migrated from Finland, Bosnia and Herzegovina, Croatia, Montenegro or Serbia to Sweden were randomly allocated to a health promotion programme or a control group. The programme was linguistically adapted with regard to translated information material, bilingual health professionals and evaluators, and a person-centred approach was applied to both programme development and provision. The data analysis was explorative and descriptive.

RESULTS

The results visualized structural and linguistic barriers to recruitment and study questionnaire administration, and describe strategies for how to bridge them. Retention rates and data variability were satisfying.

CONCLUSIONS

Calling for iterative and pragmatic programme design, the findings describe how to move towards a more inclusive health care environment. Person-centred and bilingual approaches with attention to the possibilities for building authentic relationships between participants and providers are emphasized, and a structured methodology for developing study questionnaires is suggested.

Health-related quality of life and sense of coherence among Polish immigrants in Germany and indigenous Poles

Immigrants are faced with several impediments in the host country that may affect their quality of life (QoL), but little is known about the impact of these stressors as well as about the protective role of sense of coherence (SoC) in the context of Polish immigration to Germany. Health Related QoL (Short Form Health Survey SF-36) and SoC (Sense of Coherence Scale SOC-29) were assessed in a total sample consisting of 511 participants aged between 18 and 84 years (260 Polish immigrants in Germany and 251 indigenous Poles). Polish immigrants reported a significantly lower mental and physical health-related QoL than the German norm population, but they were comparable to native Poles. This result remained the same when the model was adjusted for age but physical health status was better for immigrants compared with indigenous Poles. Both groups scored significantly lower for SoC than Germans, but did not differ from each other. The main differences concerning the examined variables were with respect to the German norm population and are putatively shaped by culture.

A person-centred approach to health promotion for persons 70+ who have migrated to Sweden: promoting aging migrants' capabilities implementation and RCT study protocol

Background

There are inequities in health status associated with ethnicity, which may limit older foreign-born persons’ ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study ‘Promoting Aging Migrants’ Capabilities’ was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula.

Methods/Design

This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings (‘senior meetings’) and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated.

Discussion

The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context.

Trial registration

The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.

Migration and common mental disorder: an improvement in mental health over time?

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.

Embraced by the past, hopeful for the future: meaning of health to ageing persons who have migrated from the Western Balkan region to Sweden

Previous research has often visualised ageing and migration as risk factors for poor health, pointing to a need for targeting health-promoting efforts towards ageing persons who are born abroad. However, most research has been conducted from an objective and poor health perspective, losing the broader picture of health in the context of ageing and migration. A key issue left unexplored is the meaning of health from a subjective perspective with focus upon persons who constitute the target groups for health promotion and other health-care services. A large number of people are now ageing in countries other than their country of birth. Therefore, studying the meaning of health in relation to this part of the population is of growing importance. As part of a larger health promotion project, the aim of this study was to explore the meaning of health to ageing persons who have migrated from the Western Balkan region to Sweden. Data were collected by individual interviews, conducted in the participants' mother tongue. Inspired by Ricoeur's hermeneutic approach, health was interpreted as a retrospective and prospective process of exercising control over one's own life, daily activities and social commitments. This interpretation is discussed in relation to how a person-centred approach to health-care services could bridge health inequities in an ageing and globalising society.

Ethnicity does not account for differences in the health-related quality of life of Turkish, Moroccan, and Moluccan elderly in the Netherlands

BACKGROUND

Data on how different groups of elderly immigrants perceive health-related quality of life (HRQOL) is scarce and research on the influence of ethnicity on HRQOL across ethnic groups is missing. Measuring HRQOL may help to detect cross-cultural differences and to decide whether ethnic-specific health and prevention programmes are required to improve HRQOL. We investigated differences in HRQOL among three elderly immigrant populations with a special focus on the contribution of ethnicity, in addition to other well-known determinants, to HRQOL.

METHODS

Data were collected between October 2011 and July 2012 as part of the project entitled "Stem van de oudere migrant", a quasi-experimental study in the Netherlands focussing on health of immigrant elderly. A survey was conducted among 201 elderly (aged 55 years and older) Moroccans (98), Turks (69), and Moluccans (34). HRQOL was assessed using the SF-12, measuring physical and mental health composite scores (PCS resp. MCS). Chi-square tests and ANOVAs were performed for group comparison. Hierarchical multiple linear regressions were conducted to examine whether ethnicity uniquely contributed to the observed variance in HRQOL when multimorbidity, loneliness, socio-demographics, and acculturation were taken into account.

RESULTS

Moroccans had the lowest scores on PCS (34.3 ± 31.4) and MCS (42.1 ± 27.0), followed by Turks (45.7 ± 27.0 for PCS and 54.7 ± 22.2 for MCS), and Moluccans (71.7 ± 21.2 for PCS and 74.4 ± 22.1 for MCS). Ethnicity was not independently associated with PCS and MCS scores, in contrast to loneliness (PCS β -0.461, p < 0.001 and MCS β -0.435, p < 0.001) and multimorbidity (PCS β -0.380, p < 0.001 and MCS β -0.398, p < 0.001). Gender was independently associated with PCS (β 0.148, p = 0.026) and attachment to Dutch culture with MCS (β 0.144, p = 0.029).

CONCLUSIONS

The lower level of HRQOL reported by elderly immigrant populations was affected by multimorbidity and loneliness but not ethnicity. Similar to native elders, interventions aiming at improving HRQOL for immigrant elderly should focus on loneliness and (mental and physical) disease. Finally, health literacy deserves attention to maintain health.

TRIAL REGISTRATION

ISRCTN89447795.

The lower quality of preventive care among forced migrants in a country with universal healthcare coverage

OBJECTIVE

To assess the association between socio-demographic factors and the quality of preventive care and chronic care of cardiovascular (CV) risk factors in a country with universal health care coverage.

METHODS

Our retrospective cohort assessed a random sample of 966 patients aged 50-80years followed over 2years (2005-2006) in 4 Swiss university primary care settings (Basel/Geneva/Lausanne/Zürich). We used RAND's Quality Assessment Tools indicators and examined recommended preventive care among different socio-demographic subgroups.

RESULTS

Overall patients received 69.6% of recommended preventive care. Preventive care indicators were more likely to be met among men (72.8% vs. 65.4%; p<0.001), younger patients (from 71.0% at 50-59years to 66.7% at 70-80years, p for trend=0.03) and Swiss patients (71.1% vs. 62.7% in forced migrants; p=0.001). This latter difference remained in multivariate analysis adjusted for gender, age, civil status and occupation (OR 0.68; 95% CI 0.54-0.86). Forced migrants had lower scores for physical examination and breast and colon cancer screening (all p≤0.02). No major differences were seen for chronic care of CV risk factors.

CONCLUSION

Despite universal healthcare coverage, forced migrants receive less preventive care than Swiss patients in university primary care settings. Greater attention should be paid to forced migrants for preventive care.

Portuguese migrants in Switzerland: healthcare and health status compared to Portuguese residents

Background

Most migrant studies have compared health characteristics between migrants and nationals of the host country. We aimed at comparing health characteristics of migrants with nationals from their home country.

Methods

Portuguese national health survey (2005-6; 30,173 participants aged 18-75 years) and four national health surveys conducted in Switzerland (2002, 2004, 2007 and 2011, totalling 1,170 Portuguese migrants of the same age range). Self-reported data on length of stay, cardiovascular risk factors, healthcare use and health status were collected.

Results

Resident Portuguese were significantly older and more educated than migrants. Resident Portuguese had a higher mean BMI and prevalence of obesity than migrants. Resident Portuguese also reported more frequently being hypertensive and having their blood pressure screened within the last year. On the contrary, migrant Portuguese were more frequently smokers, had a medical visit in the previous year more frequently and self-rated their health higher than resident Portuguese. After adjustment for age, gender, marital status and education, migrants had a higher likelihood of smoking, of having a medical visit the previous year, and of self-rating their current health as good or very good than resident Portuguese. Compared to Portuguese residents, cholesterol screening in the previous year was more common only among migrants living in Switzerland for more than 17 years.

Conclusion

Portuguese migrants in Switzerland do not differ substantially from resident Portuguese regarding most cardiovascular risk factors. Migrants consider themselves healthier than Portuguese residents and more often had a recent medical visit.

Psychometric analysis of the Swedish translation of the WHO well-being index

PURPOSE

The purpose of this study is to validate the Swedish translation of the WHO (Ten) and WHO (Five) Well-Being Questionnaires among three samples of Swedes.

METHODS

Baseline data collected in 2008 from the Health Assets Project are the data source consisting of three cohorts of Swedes aged 19-64 years: (1) a randomized general population cohort (n = 4,027); (2) employees sick-listed reported by the employer (n = 3,310); and (3) self-certified sick-listed individuals (n = 498). The psychometric properties of the scales are assessed using factor analysis, Cronbach's alpha, and examination of the relationship between scale scores and participants' self-reported adverse health conditions.

RESULTS

Factor analysis revealed a unidimensional factor structure for both scales, and Cronbach's alphas are very good to excellent. The scales correlate in the expected direction with almost all of the adverse health conditions considered.

CONCLUSIONS

The Swedish translation of the WHO (Ten) and WHO (Five) Well-Being Questionnaires is psychometrically sound, but the first item of both scales has weaker psychometric qualities in comparison with other scale items.

Depressive symptoms in first-and second-generation migrants: a cross-sectional study of a multi-ethnic working population

BACKGROUND

Migrants in Europe may suffer from depression more often than the native-born population of the particular host country. Reports about the prevalence of depression in migrants are, however, heterogeneous and the possible causes are the subject of controversial discussion.

AIMS

The aims of this study are to determine the incidence of depressiveness in a large multi-ethnic working population with and without a history of migration, and to investigate possible connections with migration status and acculturation criteria.

METHODS

The cross-sectional study asked 7062 employees of a university hospital to complete a self-rating questionnaire concerning socio-demographic data, migration status and indicators of acculturation. Depressiveness was assessed by means of the German version of the Center of Epidemiological Studies Depression Scale (CES-D).

RESULTS

The response rate was 41.7% (N = 2932); 14.9% of the participants (n = 419) reported a history of migration, 275 (65.8%) of whom were first-generation (M1) and 143 (34.2%) second-generation (M2) migrants. According to the CES-D scores, 8.7% of non-migrants (n = 207) suffered from clinically relevant depressive symptoms, compared to 16% (n = 44) of the M1 group (OR = 2.10, 95% CI: 1.44-3.04, p < .001) and 14% (n = 20) in M2 (OR = 1.68, 95% CI: 1.01-2.79, p = .048). Taking gender into consideration revealed that only the female migrants showed a statistically significant increased rate of depressiveness (χ (2) = 16.68, p < .001).

CONCLUSIONS

Our results suggest that first- and second-generation female migrants are more likely to suffer from depressiveness than non-migrant females. In this model a history of migration is shown to be an independent risk factor for depressiveness.

International migration and health inequalities in later life

The aim of this paper is to ascertain the existence of differences in self-perceived health and depression between immigrants and native-born populations aged 50 years and older living in Western and Northern European countries. We examine the effect of country of origin, length of time in the host country and citizenship on the health of adults, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). As the logistic regressions reveal, some immigrant groups are more likely to perceive worse self-rated health and to suffer from depression than native-born groups, even when demographic and socio-economic variables are taken into account. In particular, people born in Eastern Europe living in Germany, France and Sweden have the highest odds ratio of poor health with respect to natives. Nativity status, duration and citizenship clearly contribute towards explaining health differences which are shown to vary significantly across countries. Furthermore, the perception of poor health rises as the length of stay increases, although a non-linear pattern was found. Results indicate that greater efforts by policy makers are needed in order to improve the health of specific middle-aged and older groups of immigrants in Europe.

Healthcare for migrants and for marginalized individuals: The Marienambulanz in Graz, Austria

The Marienambulanz in Graz, which was founded in 1999, is an outpatient clinic aiming to provide free medical services for marginalized groups. Medical and socioeconomic data of patients at the outpatient clinic have been collected electronically since 2003. The purpose of this study was to find out which persons were treated at the Marienambulanz in the last seven years (2003-2009) and to find out the most frequent reasons for attending the Marienambulanz. We analysed existing medical data descriptively in order to find out the four most frequent reasons for going to the outpatient clinic, the nationality of the patients and whether or not the patients had insurance coverage. Since 2003, 3,652 patients (2,342 men and 1,310 women) have been treated at the Marienambulanz. The majority of patients came either for an initial medical examination, for medication or for further thorough examinations including advice about general health and - if necessary - for childcare. Interestingly, more than 60% of the patients were insured. The Marienambulanz provides medical assistance for uninsured persons and for marginalized insured persons who do not make use of the regular health care system. It can be argued that the regular Austrian health care system fails to provide health care for marginalized groups. The Marienambulanz in Graz, as a low-threshold institution, serves the purpose of bridging the gap to the regular health care system for marginalized groups.

Factors of importance for self-reported mental health and depressive symptoms among ages 60-75 in urban Iran and Sweden

BACKGROUND

Depression is a common experience affecting 121 million people around the world. In high income countries, depression is one of the most common psychiatric conditions among the elderly. Studies show that immigrants are particularly at risk for mental ill health.

AIM

This study investigates the self-reported mental health among two Iranian groups; one born and residing in Iran and one consisting of Iranian immigrants in Sweden, as well as native Swedes living in Sweden. The study also aims to explore and compare self-reported depressive symptoms among three groups.

METHODS

This study is based on a cross-sectional design measuring self-reported health with a study specific questionnaire. The programme SPSS V.17.0 was used for all statistical analyses.

FINDINGS

1088 participants were approached (668 Iranians in Iran; 105 immigrated Iranians in Sweden; and 305 Swedes in Sweden). Factors effecting self-reported mental health was self-reported health, smoking, satisfaction with social life and also a sense of connection to ones cultural roots and traditions. Also demographic variables such as group belonging (Swedes vs. Iranians), sex and satisfaction with Income were shown to be important when performing the regression analysis. In the chi-square analysis the Iranian samples reported depressive symptoms to a larger extent than the Swedish group in all aspects of self-reported depressive symptoms. Self-reported depressive symptoms were reported to a greater extend in women compared to men. Our findings indicate that the Iranian populations living in both Tehran and Stockholm report depressive symptoms to an extent that merits concern. The findings indicate that Iranians living in Tehran and Iranians who have immigrated to Sweden require more attention regarding mental health care. Health care providers in both countries should be aware of the current state of mental health among Iranians in both Sweden and Iran.

Differences in self-rated health among older immigrants--a comparison between older Finland-Swedes and Finns in Sweden

AIMS

Research has shown a tendency among immigrants and ethnic minorities to have a lower health status compared with the majority population. This applies to Finnish immigrants in Sweden. This group, however, also consists of persons who belong to a small ethnic minority in Finland, the Finland-Swedes, who speak Swedish as their mother tongue. In Finland, this minority has been shown to have better health and longer lives than the majority of Finnish-speaking people. Most of the previous research has studied the objective health of immigrants and minorities, while less is known about their subjective health. The aim of this study was to describe and compare self-rated health in older Finland-Swedes and Finns living as immigrants in Sweden.

METHODS

The study was carried out as a sample-based cross-sectional study. Data was collected by a postal structured questionnaire. The response rate among the Finland-Swedes was 47% (n = 169) and among the Finns was 54% (n = 643). Data was analyzed descriptively and tested with Pearson's chi-square test.

RESULTS

The results showed significant differences between the language groups in self-rated health, age of retirement and causes for retirement. The Finland-Swede immigrants rated their health as better than the Finnish-speaking ones. They had retired at an older age and less frequently because of health problems.

CONCLUSIONS

The results indicate that there may be significant differences in health, at least in subjective health, between immigrant groups. Due to the low response rate, the results cannot be generalized.

Health-related quality of life and migration: a cross-sectional study on elderly Iranians in Sweden

Background

Although elderly Iranian immigrants in Sweden are the largest elderly group born outside Europe, little is known about their health-related quality of life (HRQL). The aim of this study was to examine the association between migration status and HRQL in a comparison of elderly Iranians in Iran, elderly Iranian immigrants in Sweden, and elderly Swedes in Sweden.

Methods

The Short Form Health Survey (SF-36) was administered to a total of 625 men and women aged 60–84 years to collect HRQL information on elderly Iranians in Sweden (n = 176) and elderly Iranians in Iran (n = 298). A Swedish control group (n = 151) was also randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age, which was categorized into 60–69, and 70–84 years, and education.

Results

Iranian women in Sweden with shorter times of residence scored lower on vitality (β-coefficient = -7.9, 95% CI = -14.3 to -1.5) compared with other women in this study. The lower vitality dimension score remained nearly unchanged in the main model (β-coefficient = -7.3, 95% CI = -13.7 to -0.9). A longer period of residence in Sweden had a positive association with social functioning (β-coefficient = 14.1, 95% CI = 3.1–25.1) and role limitation due to emotional problems (β-coefficient = 18.3, 95% CI = 1.4–35.2) among elderly Iranian women. In general, the Swedish subsample scores higher on all dimensions of the SF-36 among women and in six out of eight among men in relation to the rest of the subsamples.

Conclusion

The HRQL of elderly Iranians in Sweden was more like that of their countrymen in Iran than that of Swedes, who reported a better HRQL than Iranians in this study. However, length of time since migration to Sweden is not associated with poorer HRQL among elderly Iranians. The association varied, however, with sex. Elderly Iranian women showed an increase in two of eight dimensions of the SF-36 with additional years in Sweden, whereas, among elderly Iranian men, additional years in Sweden were not associated with HRQL.

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands

BACKGROUND

Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors.

METHODS

330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions.

RESULTS

The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis.

CONCLUSIONS

The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.

Changes in mental health status amongst children of migrants to Australia: a longitudinal study

This paper examines the mental wellbeing of children of Australian migrants. Migration can be viewed as a natural experiment in which persons of one culture have their beliefs, values and behaviours challenged by the host culture. Such a process could be expected to lead to impaired mental health amongst migrants and their children. This paper investigates the relationship between migrants' region of origin, length of stay in Australia and indicators of impaired mental health. The data were taken from the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal study of mothers and children which started in Brisbane, Australia, in 1981. The study comprises a cohort of over 5,000 women interviewed at their first ante-natal clinic visit and followed up at 3-5 days, six months, 5 and 14 years after the baby was born. Results showed no significant differences between the mental health of 'second generation' children and their Australian counterparts. Length of stay in Australia was not associated with internalising symptoms (anxiety and depression). There was a positive association, however, between the length of stay in Australia and increased externalising problems (aggression and delinquency) amongst the children at both 5- and 14-years follow-up. We conclude that children of migrants do not differ from comparable children of Australian-born parents in their mental health. Children of migrant parents have fewer symptoms of some behaviour problems in the years after their arrival in Australia, but these rates increase to the Australian level over time.